Learning together increases open communication and mutual respect
Before medicine became so specialized or new technology so freely available, the team delivering care to a patient was small and able to communicate easily. Today, multiple professionals, including everyone from emergency physicians, surgeons, and nurses to social workers, pharmacists, and rehab personnel, must work together to do what is best for the patient. “Medicine has come to the point where it has so many moving parts,” says Paul Haidet, M.D., M.P.H., ’91, ’94R, director of medical education research, Penn State College of Medicine. “What needs to happen is people seeing how their role fits in the big picture and coordinating with others in that picture to benefit the patient.”
That is exactly what the College of Medicine and School of Nursing had in mind when they collaborated on a new project to improve health care delivery. Initially funded through a Josiah Macy, Jr. Foundation grant, the project brings together fourth-year nursing students and first-year medical students in a series of workshops that focus on safety and quality issues. The need for this type of interprofessional education came out of recent studies related to quality improvement, according to Mary Beth Clark, R.N., Ed.D., assistant professor of nursing, School of Nursing—Penn State Hershey Campus Coordinator. “More and more attention is being paid to patient safety and quality improvement. When there is a medication error, it is not really just one person’s issue. Many times it is a system-wide error that leads to the mistake,” explains Clark, who is responsible, together with Haidet, for the coordination of the interprofessional quality and safety curriculum in health sciences education. “You have to look at the system and how it is designed to help people interact and communicate with each other.The idea grew that this should start in the education process.”
Although there has been informal collaboration within these programs in the past, the time was ripe to try something more formal, according to Haidet. A growing number of articles within both nursing and medical literature called for interprofessional education. At the same time, members of the health care profession realized they could no longer deliver care with a singular focus. “We talk about healthcare teams and how the patient safety movement is all about teamwork, but traditionally, if you look at people and what they are doing, it would be hard to call that a team because there is no coordination,” says Haidet. “People cannot communicate to coordinate actions until they can see what is happening from the various different perspectives that are looking at it.”
With that in mind, Haidet and Clark developed two workshops meant to foster skills that mirror the practice environment as closely as possible. “Specifically, such education should be interprofessional, team-based, and grounded in the application of core concepts to real-world problems and issues,” says Clark. “Our eight-hour curriculum is built on existing Institute for Healthcare (IHI) Open School courses and creates a classroom environment that fosters productive relationships between nursing and medical professionals.”
First offered in the fall semesters of 2009 and 2010, the workshops have generated positive feedback from students and have them rethinking the way in which they will provide care. Michael McShane, now a second-year medical student, believes the workshops went a long way toward opening his eyes to the viewpoints of others. “From the very beginning of my career, learning with other health professionals was something I didn’t think about, but it is something I’ve come to value,” he says. “We now have an opportunity to interact with nursing students in the first and second year of medical school and that rarely happens. It was interesting to see what they bring to the table.”
For Emily Barlett, R.N., B.S.N., who graduated from Penn State’s School of Nursing in May and now works for the Medical Center, the workshops provided a refreshing way to learn new ideas. “Nurses and doctors, at this point, are trained in very different ways, and the approach to the care of patients for each discipline is different because of this. Bringing medical and nursing students together created a mutual mutual respect for each other’s own unique knowledge and experiences,” she says, adding the curricula had a profound impact on her current practice.
“The training I received helped ease my transition from student nurse to registered nurse. So much of patient safety and quality improvement comes down to effective communication. If it had not been for the workshops and other interdisciplinary experiences offered by the College of Medicine and School of Nursing, I would not feel as comfortable communicating across disciplines about specifics concerns and questions I have about patients.”
The biggest challenge for educators moving forward with this type of education is how to help students navigate the different mindsets of the various professionals they will encounter, Haidet believes. “This is about helping our learners have the tools they need to look at something through their own lens, but to also see it as it could be seen from different lenses,” he says. “Then, they need to communicate with folks from other professions so the team comes to a shared understanding of what needs to go on.”
Penn State is not alone in this challenge, as Clark and Haidet have found in their discussions with faculty from other institutions, but they are confident that they and their counterparts will continue to move forward. “What we’ve started is a foundation,” says Clark, pointing to another interprofessional endeavor started this semester. “That initiative focuses on end-of-life care and interdisciplinary communication among health care team members.”
No matter the topic, it must be something that makes sense to the faculty and the students, Haidet believes.
“As educators, we have a responsibility if we are going to do something to figure out what it means and how students change and grow,” he says. “It requires a bigger responsibility from us not only to build educational experiences and teach them, but to study the issues and determine where it makes the best sense to have them learn together, what the goals of the experiences are, and how we measure whether we are achieving those goals.”
– By Jean Waverka